Why investigate after 6 months

In some cases, it may be appropriate to start an infertility investigation after 6 months of trying to conceive. Reasons to start the investigation sooner include:

• If the woman is over 35 years of age
• If she has irregular periods or no periods at all
• If she has had pelvic surgery or a pelvic infection in the past
• If the man has a past history of genital surgery, genital infection or trauma to the testes.

The initial tests in a fertility investigation may be done by your GP but for more advanced tests it is best to be referred to an infertility specialist. You should see both your GP and the specialist as a couple so that both partners can be investigated simultaneously. Another important reason for participating as a couple is to give each other support throughout the process, which at times can get frustrating and stressful.

At the first consultation the doctor will usually do a physical examination of both the woman and the man and take a thorough history. The questions asked will sometimes give clues to what may cause the infertility.

Questions to expect
This list gives an idea of the kind of questions you can expect and explains why they are asked:

• Your age, because it affects fertility, particularly the woman’s, but to an extent also the man’s age
• The regularity of the woman’s periods - this gives important information about how frequently ovulation occurs (so keep a record of your period dates)
• If periods are very painful, because this may point to endometriosis
• Questions about previous pregnancies and the outcome of those are always asked
• If either of you have had surgery or physical trauma in the past that may have involved the reproductive organs, this could point to a problem related to that surgery or trauma
• If the woman has had a pelvic infection or used an IUD in the past, this might suggest that the Fallopian tubes are blocked
• If the woman’s Body Mass Index (BMI, the relationship between height and weight) is very high the reason for infertility could be Polycystic Ovarian Syndrome
• If the man’s occupation involves hazardous chemicals this may affect sperm production
• How often and when in the cycle you have intercourse is important to know - the problem may simply be that pregnancy does not happen because you try at the wrong time
• Questions about life style- smoking, alcohol intake, diet, etc - will be asked because some life style factors affect fertility and chance of pregnancy

When all the information has been gathered the doctor will order some tests.

Tests & investigations

The man will be asked to have one and sometimes two semen analyses. If the test result is abnormal, the doctor may order blood tests to uncover the reason.

For the woman, many more tests and investigations are often needed to find the cause of infertility. These include:

• Hormone tests to monitor ovulation. Some doctors also ask the woman to take her temperature each day (BBT, Basal Body Temperature) and record it. Just before ovulation the body temperature often rises slightly and this indicates ovulation. However, it is quite stressful to do BBT over several months and it is of limited value because some women ovulate even when no temperature rise shows up.
• A vaginal ultrasound examination by a specialist ultrasonographer can be a very good diagnostic tool. Things like PCOS (”Polycystic Ovary Syndrome), fluid filled fallopian tubes, fibroids and polyps, endometriosis or other cysts can be detected with an ultrasound scan.
• A hysterosalpingogram is an x-ray examination which gives information about the inside of the uterus (uterine cavity) and whether the Fallopian tubes are open or blocked
• A hysteroscopy allows the doctor to inspect the uterine cavity
• A laparoscopy is a surgical procedure where an optic instrument is inserted close to the navel giving the doctor the opportunity to examine the uterus, Fallopian tubes and ovaries for any abnormalities. You need a general anaesthetic and a day in hospital to have a laparoscopy.

An infertility investigation should take no more than 3-4 months. Male and female causes of infertility are equally common. Of couples who go through an infertility investigation a female cause is found in about 40% and a male cause in 40% of cases, but for 20%, no cause is found. Very rarely is the infertility absolute, meaning that there is a small chance of conception occurring naturally every month. That’s why it is useful to try to have intercourse around ovulation time. even when you have started an infertility investigation.